Post-traumatic urethral obliteration, particularly involving the membranous and proximal bulbar segments, presents a significant reconstructive challenge. Such injuries often result from blunt perineal trauma, leading to complete disruption of the urethral lumen and long-term dependence on suprapubic diversion. We present the case of a 54-year-old male with a history of Coronary Artery Disease (CAD) who suffered blunt perineal trauma in 2023. Since the accident, the patient had been unable to void transurethrally and was managed exclusively with a suprapubic catheter. This video abstract demonstrates the surgical management of a complete proximal urethral obliteration using an Anastomotic Urethroplasty approach.

A detailed preoperative assessment was conducted to define the anatomy of the distraction defect: Clinical Status: Total absence of urethral output since the trauma. Imaging: Urethral MRI revealed a complete obstructive lesion, approximately 1 cm in length, involving the junction of the membranous urethra and the proximal part of the bulbar urethra. Surgical Strategy: Given the short segment (1 cm) and the location, an end-to-end anastomotic urethroplasty was planned. The procedure involved: Perineal access and mobilization of the bulbar urethra. Precise excision of the fibrotic, obliterated segment. Spatulation of the urethral ends to ensure a wide, tension-free anastomosis over a Foley catheter.

The anastomotic repair was successfully completed, despite the patient’s cardiovascular comorbidity (CAD). Perioperative Outcomes: No significant intraoperative complications occurred. The precise excision of the 1 cm scar tissue allowed for healthy mucosal apposition. Follow-up: Following the removal of the transurethral catheter, the patient regained spontaneous and unobstructed voiding for the first time since 2023. Functional Recovery: The suprapubic catheter was successfully removed. The patient maintained urinary continence, and follow-up uroflowmetry showed excellent flow rates, consistent with a successful anatomical reconstruction.

Anastomotic urethroplasty remains the treatment of choice for short-segment (≤2 cm) complete urethral obliterations following blunt perineal trauma. This case highlights that even in patients with systemic comorbidities like CAD, a meticulous perineal approach can provide a definitive cure, eliminating long-term suprapubic catheter dependency. Precise imaging with MRI is crucial for localized surgical planning at the membranous-bulbar junction to ensure successful excision of the fibrotic segment and a tension-free repair.

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Andrich, D. E., & Mundy, A. R. (2013). "The nature of urethral distraction defects and the techniques of operative repair." BJU International.
Chapple, C., et al. (2014). "SIU/ICUD Consultation on Urethral Strictures: Posterior urethral condition." Urology.

Continence 19S (2026) 102738
DOI: 10.1016/j.cont.2026.102738